Medical pump

ABSTRACT

A medical pump, comprising: a fluid housing having a plurality of intake openings, sealed by at least one intake valve, and an outlet opening sealed by an outlet valve; a piston which is sealing the fluid housing and connected to a drive mechanism, the drive mechanism pulls the piston to draw fluid from one of the plurality of intake openings and pushes the piston to discharge the fluid into the outlet opening; and a selecting valve enclosing at least two tubes, each providing fluid to one of the plurality of intake openings, wherein the selecting valve closes one of the at least two tubes while opening another of the at least two tubes.

RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.16/110,016 filed on Aug. 23, 2018, the contents of which areincorporated herein by reference in their entirety.

FIELD AND BACKGROUND OF THE INVENTION

The present invention, in some embodiments thereof, relates to a medicalpump and, more particularly, but not exclusively, to structure,operation methodology and corresponding algorithms of a medical pump forcontinuously selecting and discharging multiple fluids.

Medical pumps are intensively used in the hospital and clinicenvironment for a long time, performing a variety of tasks such asassisting feeding patients, administering medications and rinsing.

In some of these applications, precision metering (exact flow ratecontrol) is not critical while in other cases exact flow rate and as inthe case of medication administration the total quantity is extremelycritical. As a result of the large spectrum of specifications, largevariety of medical pumps have been invented and are in production.

When dealing with feeding pumps most are based on peristaltic principlewere a polygonal rotor is pushing fluids into a flexible tube. Thiscurrent approach has a few disadvantages such as sensitivity to cloggingand lack of sufficient accuracy, yet it is in use as it offersacceptable performance and incorporates low cost disposable parts thatare in contact with the patient, thus avoiding the need to sterilize thepump.

In addition to the dispensing of food as described pumps are also usedfor dispensing water to the patient for several reasons such as:reducing the concentration of Sodium (Na⁺) by water dilution andflushing the feeding tube in case of clogging.

Medication, when required, may be administered via the pump by crashingthe solid agent to powder and mixing it with water to create a liquidphase or in some cases the medication is supplied as a liquid in thefirst place.

SUMMARY OF THE INVENTION

According to an aspect of some embodiments of the present inventionthere is provided a medical pump system, comprising: a fluid chamberhaving at least two intake openings, sealed by at least one intakevalve, and an outlet opening sealed by an outlet valve; a piston whichis sealing the fluid chamber and connected to a drive mechanism, thedrive mechanism pulls the piston to draw fluid from one of the least twointake openings and pushes the piston to discharge the fluid into theoutlet opening; and a selecting valve enclosing at least two tubes, eachproviding fluid to one of the at least two intake openings, wherein theselecting valve closes one of the at least two tubes while openinganother of the at least two tubes.

Optionally, the drive mechanism is controlled by an electronic controlunit.

Optionally, the selecting valve is controlled by an electronic controlunit.

Optionally, at least one of the selecting valve, the at least one intakevalve and the outlet valve is a one way valve.

Optionally, the selecting valve is instructed by an electronic controlunit to alternately open and close the at least two tubes.

More optionally, the electronic control unit is connected to a displaydevice, graphically displaying data related to operation of the medicalpump system.

More optionally, the electronic control unit is connected to anelectronic health record (EHR).

More optionally, the electronic control unit provides instructions whichcompensate for food losses due to gastric residual volume (GRV) andreflux feeding pause.

Optionally, the selecting valve is controlled using Pulse-widthmodulation (PWM) algorithm.

Optionally, the pump and the at least two tubes are disposable.

Optionally, the selecting valve is a pinch valve.

Optionally, the fluid chamber includes a cylinder.

Optionally, the piston is connected to the drive mechanism via a plungerrod having a slit which holds a reciprocating drive bracket of the drivemechanism and transfers reciprocal motion of the drive mechanism.

More optionally, the reciprocating drive bracket includes a fork typeholder holding the slit.

Optionally, the drive mechanism is adjusted by an electronic controlunit to administer a medication from a fluid dispenser connected to oneof the at least two intake openings.

Optionally, one of the at least two tubes includes a fluid dispenserhaving a detachable fluid container.

Optionally, the at least two intake openings are connected into anintake channel.

Optionally, the at least one intake valve and the outlet valve areincorporated in a valve box.

According to an aspect of some embodiments of the present inventionthere is provided a fluid dispenser for a medical pump that may beattached to an inlet tube, comprising: a housing having an inletopening, and an outlet opening connected to an intake opening of amedical pump; a piston enclosed in the housing, the piston having aninlet channel and a dispensing channel, wherein when the piston is in areleased position, fluid flows from the inlet opening to the outletopening via the inlet channel; and a detachable fluid container, whereinwhen the detachable fluid container is attached to the piston, thepiston is moved to a pushed position and fluid flows from the detachablefluid container to the outlet opening via the dispensing channel.

According to an aspect of some embodiments of the present inventionthere is provided a method of controlling a medical pump, comprising:instructing a selecting valve enclosing at least two tubes, eachproviding fluid to one of a plurality of intake openings of a fluidhousing, to close one of the at least two tubes while opening another ofthe at least two tubes; instructing a drive mechanism to pull a pistonwhich is sealing the fluid chamber, the fluid chamber having the atleast two intake openings and an outlet opening, to draw fluid from anopen one of the least two tubes; and instructing the drive mechanism topush the plunger to discharge the fluid into the outlet opening.

According to an aspect of some embodiments of the present inventionthere is provided a method of preventing clogs in a feeding tube whilefeeding using a medical pump, comprising: pumping into a feeding tube atleast one stroke of softening fluid, the at least one stroke ofsoftening fluid fills a predetermined length of the feeding tube;pumping into the feeding tube at least one filling stroke of feedingfluid, so that the at least one stroke of softening fluid is pushed to adistal end of the feeding tube; pausing the pumping for a predeterminedtime to soften a clog in the distal end by the at least one stroke ofsoftening fluid; and pumping into the feeding tube at least one flushingstroke of feeding fluid at a faster rate to remove the clog.

Optionally, the method further comprises pumping into the feeding tube aplurality of strokes of feeding fluid, so a total amount of theplurality of strokes of feeding fluid, the at least one filling strokeof feeding fluid and the at least one flushing stroke of feeding fluidduring a feeding cycle is equal to a prescribed amount of feeding fluidfor the feeding cycle.

Optionally, the method further comprises pumping into the feeding tube aplurality of strokes of softening fluid, so a total amount of theplurality of strokes of softening fluid and the at least one stroke ofsoftening fluid during a feeding cycle is equal to a prescribed amountof softening fluid for the feeding cycle.

Optionally, the method further comprises detecting a rise in powerconsumption of a medical pump, indicating clogging of feeding fluidinside the feeding tube.

More optionally, the method further comprises pumping into the feedingtube a plurality of strokes of fluid at a faster rate to remove theclogging.

Optionally, the softening fluid is water.

Optionally, the predetermined length is between 5 and 15 centimeters.

Optionally, the predetermined time is at least 1 minute.

According to an aspect of some embodiments of the present inventionthere is provided a method for safe administration of medication,comprising: comparing prescription data of a medication to a patientstored by a terminal associated with the patient, with prescription datastored on a radio-frequency identification (RFID) device associated witha medication issued by a pharmacy; and when a match is found,instruction administration of the medication to the patient according tothe data.

Optionally, the data includes at least one of medication type, dose,administration and patient ID.

Optionally, the terminal is stored at a bedside of the patient.

Optionally, the RFID device is attached to container of the medication.

According to an aspect of some embodiments of the present inventionthere is provided a disposable feeding set for a medical pump system,comprising: a fluid chamber having at least two intake openings, sealedby at least one intake valve, and an outlet opening sealed by an outletvalve; an outlet tube connected to the outlet valve; at least two intaketubes, each connected to one of the at least two intake openings; atleast two fluid bags, each connected to one of the at least two intaketubes; a piston sealing the fluid chamber to be connected to a drivemechanism, the drive mechanism pulls the piston to draw fluid from oneof the least two intake openings and pushes the piston to discharge thefluid into the outlet opening; and a selecting valve enclosing the atleast two intake tubes, wherein the selecting valve closes one of the atleast two intake tubes while opening another of the at least two intaketubes.

Unless otherwise defined, all technical and/or scientific terms usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which the invention pertains. Although methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of embodiments of the invention, exemplarymethods and/or materials are described below. In case of conflict, thepatent specification, including definitions, will control. In addition,the materials, methods, and examples are illustrative only and are notintended to be necessarily limiting.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

Some embodiments of the invention are herein described, by way ofexample only, with reference to the accompanying drawings. With specificreference now to the drawings in detail, it is stressed that theparticulars shown are by way of example and for purposes of illustrativediscussion of embodiments of the invention. In this regard, thedescription taken with the drawings makes apparent to those skilled inthe art how embodiments of the invention may be practiced.

In the drawings:

FIG. 1 is a schematic basic block diagram illustration of a medicalpump, according to some embodiments of the present invention;

FIGS. 2A and 2B are schematic illustrations of a system comprising adisposable medical reciprocating pump, with the associated tubing,housed in a reusable console and outside the reusable console,respectively, according to some embodiments of the present invention;

FIG. 3A is a schematic illustration of some aspects of a systemincluding a disposable medical pump mounted inside a housing of aconsole, tubing and container bags, according to some embodiments of thepresent invention;

FIG. 3B is a schematic illustration of the system of 3A including amedication port, according to some embodiments of the present invention;

FIGS. 4A and 4B are schematic illustrations of a non-disposable selectorpinch switch when blocking inlet tube 1 and when blocking inlet tube 2,respectively, according to some embodiments of the present invention;

FIGS. 5A and 5B are schematic illustrations of a medical pump in suctionaction and discharge action, respectively, according to some embodimentsof the present invention;

FIG. 6 is a schematic illustration of a disposable feeding bag set,according to some embodiments of the present invention

FIG. 7 is an overall block diagram schematically representing a methodfor controlling a medical pump, according to some embodiments of thepresent invention;

FIGS. 8A and 8B are exemplary pump drive pulse train timing diagrams,for food, water, and a medication stroke (7B), according to someembodiments of the present invention;

FIG. 9 is a block diagram showing pump controller typical inputs andoutputs, according to some embodiments of the present invention;

FIG. 10 is a numerical exemplary pump control pulse train timingdiagrams with two water squirts per cycle, according to some embodimentsof the present invention;

FIG. 11 is a block diagram showing a typical algorithm incorporatingexemplary numerical values used for calculating the pumping and valvingpulse train including pause sessions, according to some embodiments ofthe present invention;

FIG. 12 is a detailed pump control pulse train timing diagrams of onecycle with parameters used for the pumping pulse train, according tosome embodiments of the present invention;

FIGS. 13A, 13B, 13C, 13D, 13E and 13F are schematic pump control pulsetrain timing diagrams showing the variables that are controlled by thealgorithm, according to some embodiments of the present invention;

FIGS. 14A, 14B, 14C, 14D, 14E and 14F are schematic diagrams showingexemplary typical strokes and flow schedules for preventing clogs in afeeding tube while feeding using a medical pump, according to someembodiments of the present invention;

FIG. 15 is a block diagram showing flow obscuration logic managementsensed and activated by motor overcurrent or over pressure, according tosome embodiments of the present invention;

FIGS. 16A, 16B and 16C are schematic illustrations of a feed tube havinga plug for a syringe type dispenser for a medical pump, a container of asyringe type dispenser and a syringe type dispenser connected to thetube via the plug, respectively, according to some embodiments of thepresent invention;

FIGS. 17A, 17B, 17C and 17D are schematic illustrations of anotherembodiment based on a two-part fluid dispenser for a medical pump,according to some embodiments of the present invention;

FIGS. 18A, 18B, 18C, 18D and 18E are schematic illustrations of anexemplary graphic user interface (GUI) used in operating the console,according to some embodiments of the present invention;

FIGS. 19A and 19B are block diagrams schematically representing a safetycycle of a medical pump use by a medical team, according to someembodiments of the present invention.

DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION

The present invention, in some embodiments thereof, relates to a medicalpump and, more particularly, but not exclusively, to structure,operation methodology and corresponding algorithms of a medical pump forcontinuously selecting and discharging multiple fluids.

During enteral administration of food and/or other fluids, it issometimes required to also administer water to the patient, to rinse thefeeding line and for medical treatment requiring extra water. The commonpractice today includes adding, for example every hour or more, a bolusof 250 milliliter of water for the long term medical needs of thepatient. It was observed that this practice of a large bolusadministration may result patient reflux due to the sudden stomachloading which is highly undesirable.

A bolus of 250 ml that may be dispensed within minutes every severalhours may result, for example in cases of hypernatremia, unnoticeablemassive reflux that should be always avoided since it leads toaspiration pneumonia. Sensor equipped feeding tube is able to detect theundesired reflux.

Regarding the routine water flush to prevent tube clogging, in manycases this water dispensing practice is not able to flash out theclogging since the time interval between flashings results the hardeningof the obstruction and the tubes are replaced every couple of days.

The medication administration has also shown to create undesired refluxsince it may be administrated with a syringe of a 50 cc or 100 cc, forexample, and again create reflux event.

Lately it has been shown that improving the accuracy of the feeding isessential to achieving nutritional goals and the specific feedingmaterials (caloric and protein) intake is directly related to fasterrecovery, shorter length of stay and reduced mortality rate.

Also, it has been shown that a single food selection is not the bestchoice for patient feeding and in some cases a mixed diet of two or morefood agents yields better patient convalescence.

The proposed new invention teaches how to overcome these disadvantagesof the current practice by offering a new pumping system and methodologywhich leads to much better patient feeding as dictated by the physician,by eliminating the disadvantages associated with the current systems,which also may not provide the actual feed rate as directed by thephysician.

According to some embodiments of the present invention, there isprovided a medical pump that receives two or more fluids from differentsources such as bags or containers, and administers the fluidscontinuously according to a programmed administration plan and sensoryreadings handled by a controller processor attached to the pump. This isdone by a selecting valve that select the flow from the tubes connectedto the different fluid sources, such as fluid bags, and blocks some(usually one) of the tubes while opening another of the tubes for fluidflow. The selected valve is controlled by software that is implementedin a control unit of the pump, and may be adjusted by an operator viasoftware.

Using the proposed medical pump, it is possible to precisely administera small amount of each fluid, for example a few seconds, then change toanother fluid, and repeat the process to achieve a continuous flow of amix of the different fluids. For example, this enables a much saferapproach to the water addition during feeding, by adding the neededwater at a slower rate, avoiding undesirable sudden large boluses andthus preventing the danger of reflux.

Since the operation of the pump is controlled by software, this alsoallows administering accurate portions of each fluid based on sensoryreadings, enabling the completion of the daily feeding as instructed bythe physician.

Optionally, the pump includes disposable manifold of inlet tubes, eachof the tubes may be switched on or off by non-disposable switchingvalves, such as pinch switches (pinch valves), attached to the housingand not in contact with the fluid and the patient to avoid the need forcleaning or sterilization. The disposable manifold may be designed to beeasily replaces and of low cost.

Optionally, the pump includes a reciprocating plunger which pulls thefluids from an intake opening(s) connected to the inlet tube that iscurrently selected and pushes it into an outlet opening which isconnected by a tube to the patient via corresponding suction anddischarge valves which are forming part of the disposable pump. Thisallows precision administration of the fluids by always transferring thesame exact amount of fluid—the plunger stroke. Also, the positivedisplacement guarantees that clogs in the tubes are opened since theplunger is stiff and creates the pressure buildup (positivedisplacement) required to overcome the clog, which may also bemonitored, for example, by electric current changes in the motor orpressure sensor. When there is a residual build-up, even before a fullclog is created, the software detects current consumption increase andis able to take measures before a full clog is created.

When enteral feeding a patient, it is often required to administermedication in addition to the food and water that are commonlydispensed. The common practice of bolus dispensing water with thecrashed medication or solution may result unwanted reflux, as describedabove. Therefore, it would be advantageous to administer the medicationin small portions at a time.

According to some embodiments of the present invention, there isprovided a feeding bag set that includes fluid bags, tubes, cylinderwith plunger and piston and valve box.

According to some embodiments of the present invention, there isprovided a dispenser that is connected to one of the tubes that areproviding fluids to the pump, for example as part of the feeding bagkit. The medication is then dispensed from a fluid container of thedispenser by the operation of the pump. The control unit of the pumpadjusts the pumping to a specific cycle that is desired foradministering the medication. When medication session ends the pumpresumes normal feeding and watering operation. Another embodiment isbased on adding an extra medication bag and tube controlled by anadditional switching valve.

The software-controlled switching of feeding, watering and medicationadministration in a gradual and intermitted schedule is important forthe avoidance of reflux and may not be handled manually by a care taker.

According to some embodiments of the present invention, there isprovided a method of avoiding clots at the distal end of a feeding tube,by pumping strokes of softening fluid, such as water, into the feedingtube, pumping strokes of feeding fluid that moves the softening fluid tothe distal end of the feeding tube, pausing the pumping to let thesoftening fluid to soften the clog, and then pumping fast strokes offeeding fluid to flush the clog and softening fluid. This is done, forexample, during each feeding cycle, and the amounts of fluids arecalculated to fit the total amount of each fluid as prescribed by aphysician.

The present invention presents a precision metering pump (reciprocatingand disposable) with multiple selectable fluid inputs. These fluidinputs are software selectable with the aid of switching valves.Medication may be added by an attachment, container or via an extra bagin the feeding bag kit, controlled by a switch. An easy to mountmechanism may be integrated with the controller processor for thedisposable pumping unit.

In addition, the software enables the compensation of lost feedingresulting from gastric residual volume (GRV) discharge and from pumpinghalt when reflux is sensed, both of which are detected by the system.The system has all the reflux data (i.e. the period of blocked feedingand the GRV/water and food losses) which is used as inputs for thesoftware to compensate the daily feeding to the desired predeterminedrates (calculated based on the Resting energy expenditure (REE) orHarris-Benedict equation and/or by any new regulations) as directed bythe physician. The compensation may be arranged by increasing the nexthour rate or by designing the daily feeding policy based on havingnon-active periods under undisturbed feeding, while the non-activeperiods may be used for the daily food intake compensation.

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not necessarily limited in itsapplication to the details of construction and the arrangement of thecomponents and/or methods set forth in the following description and/orillustrated in the drawings and/or the Examples. The invention iscapable of other embodiments or of being practiced or carried out invarious ways.

Referring now to the drawings, FIG. 1 is a schematic basic block diagramillustration of a medical pump, according to some embodiments of thepresent invention, emphasizing the separation into disposable systemportion and no disposable (reusable) portion. Reference is also made toFIGS. 2A and 2B, which are schematic illustrations of a systemcomprising a disposable medical reciprocating pump, with the associatedsuction and discharge valve block, housed in a reusable console andoutside the reusable console, respectively, according to someembodiments of the present invention.

The system includes a medical chamber 11, valve box 25 including inletand outlet valves, a drive mechanism 14, a control unit 15 and the feedselector pinch switch 26 (a selecting valve).

Chamber 11 may be, for example, of a cylinder shape. The size of pump 24may be, for example, 10 millimeters. Inlet feeding tubes 1 and 2 areopened by the selector pinch switch 26.

Console 10 includes the console control 15, the driving mechanism 14,housing 35 and the selector pinch switch 26. When disposable chamber 11is mounted in the housing 35 of console 10, the drive bracket 37 iscapable of pulling and pushing the plunger 22 thus performing thedesired pumping action following commands (such as rate, stroke and dutycycle as described below).

Reference is now made to FIG. 3A, which is a schematic illustration ofsome aspects of a system including a disposable medical chamber 11mounted inside a housing 35 of a console 10, tubing and container bagsof food 41 and water 42, according to some embodiments of the presentinvention. Reference is also made to FIG. 3B, which is a schematicillustration of the system of FIG. 3A including medication port 49,according to some embodiments of the present invention.

The chamber 11 is fed by at least two fluid bags and tubes 41, 42,selected by intake pinch valve 26, so that only the selected fluid maypass into the chamber 11 via inlet port 12 from the selected fluid bag.For example, fluid bag 41 is containing feed material and connected totube 31, and fluid bag 42 is containing water and connected to tube 32.The fluid is then pumped through an outlet port 13 of the chamber 11 andvia a tube to the patient. The fluids may be supplied in bags or specialcontainers depending on vendor.

Optionally, one of the tubes, for example tube 32 is connected to afluid dispenser, for example to administer a medication to the patient.FIG. 3B shows the addition of a medication port 49 as an option.

Reference is now made to FIGS. 4A and 4B, which are schematicillustrations of a non-disposable selector pinch switch 26 when blockinginlet tube 31 (FIG. 4A) and when blocking inlet tube 32 (FIG. 4B),according to some embodiments of the present invention. Thenon-disposable selector pinch switch 26 is part of console 10.

Reference is now made to FIGS. 5A and 5B, which are schematicillustrations of a medical pump in suction action and discharge action,respectively, according to some embodiments of the present invention.

Optionally, the intake valve(s) and/or the outlet valve are incorporatedin a valve box 25. Valve box 25 may be, for example, of umbrella type,duckbill type, poppet type and/or any other type.

The fluid housing of chamber 11, for example cylinder 21, includes aplunger 22 (piston rod) and a piston 23 that is sealing cylinder 21 andperforms reciprocating movement. Plunger 22 is connected to drivemechanism 14, which is controlled by control unit 15. Drive mechanism 14pulls plunger 22 and piston 23, using drive bracket 37 to draw fluidfrom one of intake tubes 31 or 32 and pushes it to force the fluid viavalve box 25 to the outlet port 13.

Optionally, plunger 22 is connected to drive mechanism 14 via areciprocating drive bracket (or arm) 37 of drive mechanism 14.Optionally, plunger 22 includes a slit that transfers the reciprocalmotion to drive bracket 37, for example via a fork shaped holder. Thisfork type design enables a quick mounting and removal of chamber 11 fromconsole 10. Drive 14 may be constructed of an electric drive motor and acrank as is known in the art.

Optionally, chamber 11 and its associated tubing are parts of adisposable feeding bag set, and are detachable from console housing 35.Optionally, the chamber 11 and tubing are made of polymer materials,which allow low cost of the disposable part.

Reference is now made to FIG. 6, which is a schematic illustration of adisposable feeding bag set (assembly), according to some embodiments ofthe present invention. The disposable feeding bag set includes bags 41and 42, tubes 31, 32 and 33, cylinder 21 with plunger 22 and piston 23,valve box 25 and optionally medication port 49.

An exemplary umbrella type valve box 25 is shown. When the plunger movesup the umbrella valve flips up, and the internal port of the umbrellavalve is closed. Fluid may flow beneath the umbrella valve and suctionis performed from active inlet. When the plunger moves down the umbrellavalve flips down and the internal port of the umbrella valve opens.

Reference is now made to FIG. 7, which is an overall block diagramschematically representing a method for controlling a medical pump,according to some embodiments of the present invention. In thisembodiment, three fluid sources are presented with the correspondingsoftware controlled selection pinch valves 76 (food, water, medication).

Command set 71 includes: food rate, water rate and medication ratesettings. The command is transferred to the controller 72 operated bysoftware 73 and activating the pump 75 via its driver 74. The system mayinclude a smart feeding tube with reflux sensors and a GRV sensor whichare used as input to the software and enable the compensation of feedlosses due to GRV discharge and due to feed blocking when reflux issensed.

Fluid bags 77 containing food, water and medication are connected to thepump through valves 76 (V1, V2, V3). 78 shows the pressure and currentsensors that feed data to the pump controller as part of synthesis ofthe pump control signal.

Reference is now made to FIGS. 8A and 8B, which are exemplary pump drivepulse train timing diagrams, according to some embodiments of thepresent invention. The diagrams show a 6 minute cycle which includes asingle water suction and discharge phase and a single food suction anddischarge phase. This pumping pulse train has a short water rinse pulseand a longer feed pulse. FIG. 7A also shows a medication administrationphase.

Reference is now made to FIG. 9, which is a block diagram showing pumpcontroller typical inputs and outputs, according to some embodiments ofthe present invention. The controller incorporates software thatprovides instructions for the system. The input set includes food rateQf [milliliters per hour (ml/hr)] Qw [ml/hr] water rate and medicationrate Qm [ml/hr]. The output set is resulting from the controllercalculations, pump rate R [cycles per second], the stroke [ml], dutycycle [%] and valves status (V1,V2,V3). Optionally, when feeding hasstopped for some intervals due to reflux as sensed by the reflux sensorsor if food was lost due to GRV, the corresponding data is delivered tothe software for calculating a compensation thus guaranteeing the properdaily feeding per physician decision.

Reference is now made to FIG. 10, which is a numerical exemplary pumpcontrol pulse train timing diagrams with two water squirts per cycle,according to some embodiments of the present invention. Reference isalso made to FIG. 11, which is a block diagram showing a typicalalgorithm incorporating exemplary numerical values used for calculatingthe pumping and valving pulse train including pause sessions, accordingto some embodiments of the present invention. Reference is also made toFIG. 12, which is a detailed pump control pulse train timing diagrams ofone cycle with parameters used for the pumping pulse train, according tosome embodiments of the present invention. The algorithm is used forperforming the calculations leading to the output parameters indicatingthe pump pulse train per cycle and the valves status. Two cases aredescribed in FIG. 11. In the first no medication is required and in thesequel 1 ml/hr medication is required. The example indicates that eachcycle is composed of two water squirts (each second cycle) followed by aslow feeding process. When medication is required it may be administeredfor example during the waterless cycle. Each water squirt takes 2seconds for suction and 2 seconds for dispensing, followed by 4 secondspause and the feeding which takes half a minute suction followed by 5minutes dispensing the food. In total, the exemplary cycle shown lasts 6min. Since the pump stroke in this example is 1.8 milliliters (ml) itleads to a feed rate of 60 ml/hr as required in the example. Thesefigures are shown as an example, however other numerical values mayresult when the system parameters, such as the stroke volume, aredifferent.

Reference is also made to FIGS. 13A, 13B, 13C, 13D, 13E and 13F, whichare schematic pump control pulse train timing diagrams showing thevariables that are controlled by the algorithm (stroke, frequency andduty cycle), according to some embodiments of the present invention.FIG. 13A and FIG. 13B demonstrate small stroke vs. large stroke,respectively. FIG. 13C and FIG. 13D demonstrate fast pumping rate vs.slow pumping rate, respectively. FIG. 13E and FIG. 13F demonstrate ahigh duty cycle vs. a low duty cycle, respectively.

Reference is also made to FIGS. 14A, 14B, 14C, 14D, 14E and 14F, whichare schematic diagrams showing exemplary typical strokes and flowschedules for preventing clogs in a feeding tube while feeding using amedical pump, according to some embodiments of the present invention.

FIG. 14A and FIG. 14B show a typical stroke of fluid when it is pulledinto the chamber from one of the intake tubes and then pushed out of thechamber into the outlet tube (feeding tube). For example, each strokecomprise of 1.8 ml of fluid. FIG. 14C shows a typical faster stroke offluid.

FIG. 14D shows an exemplary set of strokes during a one hour feedingcycle.

First, as shown at 1401, optionally, strokes of feeding fluid are pumpedinto the feeding tube to a patient.

Then, as shown at 1402, strokes of softening fluid, for example water,are pumped into the feeding tube, so they fill a predetermined length ofsaid feeding tube (for example 5 strokes). The predetermined length isdetermined according to the structure of the feeding tube clogformation. The predetermined length may be for example 10 centimeters,between 5 and 10 centimeters, or any other length.

Then, as shown at 1403, filling strokes of feeding fluid are pumped intothe feeding tube, so that the strokes of softening fluid are pushed tothe distal end of the feeding tube, where clogs are usually formed. Theamount of filling strokes of feeding fluid is determined by the lengthof the feeding tube, and together with the strokes of softening fluidshould fill the feeding tube.

Then, as shown at 1404, the pumping is paused for a predetermined timeto soften a clog in the distal end of the feeding tube by the softeningfluid. The predetermined time may be, for example, 1 minute, 5 minutes,10 minutes or any other smaller, larger or intermediate time.

Finally, as shown at 1405, flushing strokes of feeding fluid are pumpedinto the feeding tube at a faster rate to remove the softening fluid andthe clog after it is softened by the softening fluid.

The amount of feeding fluid (and optionally water) that is pumped intothe feeding tube at the first stage is calculated so that the totalamount of feeding fluid during a feeding cycle is equal to a prescribedamount of feeding fluid for the feeding cycle, for example according toa medical direction by the physician. In this example, it is required tohave a rate of 60 ml/hr of feeding fluid and a rate of 9 ml/hr of water,a total of 38 strokes of feeding fluid in a one hour cycle (for 1.8 mlstroke).

FIG. 14E shows another exemplary set of strokes during a one hourfeeding cycle. In the described example it is required to have a rate of60 ml/hr of feeding fluid (33.3 strokes) and a rate of 60 ml/hr of water(33.3 strokes) (the water flow rate may be determined, for example,according to a medical prescription by the physician). Water is pumpedat nutrition rate until feeding tube empties from nutrition. Nutritionpumped at water speed until feeding tube emptied from fluid.

FIG. 14F shows another exemplary set of strokes during a one hourfeeding cycle. In the shown example there are 30 food strokes of 1.8 ml,27 water strokes of 1.8 ml and 5 fast water flush strokes of 1.8 ml. Allstrokes are done in a 60 minutes. The exemplary cycle is yielding afeeding rate of 54 ml/hr and water rate of about 57 ml/hr.

Reference is now made to FIG. 15, which is a block diagram showing flowobscuration logic management sensed and activated by motor overcurrentor over pressure, according to some embodiments of the presentinvention. A flow obscuration in the tube results in pump back pressureincrease and/or drive current increase. This is detected, and an actionis taken, for example speeding up the strokes of fluid, adding morewater strokes or setting an alert for tube replacement.

In addition, the controller algorithm sets an alarm logic, which is notshown.

Reference is now made to FIG. 16A, FIG. 16B and FIG. 16C, which areschematic illustrations of a feed tube having a plug for a syringe typedispenser for a medical pump, a syringe type dispenser and a syringetype dispenser connected to the tube via the plug, respectively,according to some embodiments of the present invention.

Tube 32 includes a valve, such as a slide valve 1601, which closes tube32 and prevents liquid flow from the liquid bag. Tube 32 also includes adispensing opening 1602. Optionally, when in normal feeding process,opening 1602 is covered by a protection plug 1603. A fluid container1604, for example a syringe-type fluid container, may be attached (andlater detached when empty) to opening 1602 by a connector 1605 thatallows fluid flow resulting from pump suction. The syringe is connectedfor example by a luer type coupling or ENFit type coupling.

An exemplary process of administering medication via a valve typedispenser is as follows:

-   -   1. Slide valve 1601 is closed to prevent liquid flow by an        operator.    -   2. Pumping is halted. For example, the change in flow resistance        is identified by control unit 15, which halts the pumping.    -   3. Fluid container 1604 is filled with the proper amount of        medication by the operator.    -   4. Protection plug is removed by the operator.    -   5. Fluid container 1604 is coupled to the dispensing apparatus        by connector 1605 by the operator.    -   6. The desired dispensing rate on the interactive screen is        selected by the operator and inputted to control unit 15.    -   7. Pumping is resumed, for example automatically when a        dispensing rate is selected by the operator.    -   8. Pumping is halted when the dispenser has been emptied. For        example, the change in flow resistance is identified by control        unit 15, which halts the pumping.    -   9. Syringe is removed and cup is installed by the operator.    -   10. Slid valve is reopened by the operator to enable fluid flow.    -   11. Pumping is resumed until the next medication schedule.

Reference is now made to FIG. 17A, FIG. 17B, FIG. 17C, and FIG. 17D,which are schematic illustrations of another embodiment based on atwo-part fluid dispenser for a medical pump, according to someembodiments of the present invention.

The dispenser 1700 (also shown at FIG. 3B) includes a housing 1710having an inlet opening 1711 which is connected to an inlet tube thatprovides fluid, and an outlet opening 1712 which is connected to anintake opening of a medical pump, for example intake opening, via a tubesuch as tube 32.

A piston 1720 is enclosed in housing 1710. Piston 1720 includes an inletchannel 1721 and a dispensing channel 1722. Housing 1710 may include astopper pin 1715 to prevent piston 1720 from sliding out of housing1710.

When piston 1720 is in a released position, fluid flows from inletopening 1711 to outlet opening 1712 via inlet channel 1721.

The dispenser also includes a detachable fluid container 1730, forexample a container of medication. Detachable fluid container 1730 maybe attached to piston 1720, for example via a connector 1731 that allowsfluid flow, for example a luer type coupling or ENFit type coupling.When detachable fluid container 1730 is attached to piston 1720, piston1720 is moved to a pushed position and fluid flows from detachable fluidcontainer 1730 to outlet opening 1712 via dispensing channel 1722. Inpushed position, piston 1720 is pushed against a spring 1714, thusblocking the flow from the fluid bag through inlet channel 1721 andenabling flow from detachable fluid container 1730 via the dispensingchannel 1722. Optionally, when in normal feeding process, housing 1710is sealed by a protection plug 1713, so dispensing channel 1722 isclosed.

When Detachable fluid container 1730 is detached from piston 1720,spring 1714 pushes piston 1720 back to a released position, thusenabling fluid flow from the fluid bag via inlet channel 1721.

Detachable fluid container 1730 may include a container piston 1731which allows an operator to fill detachable fluid container 1730 withfluid by pulling container piston 1731, in a similar way as filling asyringe, as shown at FIG. 17C. By attaching the two parts, the plungermoves to the left, thus blocking the fluid and opening the medicationdispensing port to the pump, as shown at FIG. 17D.

An exemplary process of administering medication via a valve typedispenser is as follows:

-   -   1. Detachable fluid container 1730 is filled with the medication        by the operator.    -   2. The system is set by the operator into medication mode, for        example by pressing the interactive screen.    -   3. Medication flow rate is selected by the operator and        operation of chamber 11 is adjusted by control unit 15.    -   4. Optionally, total quantity of medication is also selected by        the operator.    -   5. Protection plug 1713 is removed by the operator.    -   6. Detachable fluid container 1730 is attached to housing 1710        by the operator.    -   7. Optionally, when total quantity is also selected, the        operator confirms that detachable fluid container 1730 is        attached, and only then the operation of chamber 11 is adjusted        by control unit 15.    -   8. Optionally, when detachable fluid container 1730 is emptied a        message is presented to the operator on the interactive screen.    -   9. When detachable fluid container 1730 is emptied it is removed        by the operator.    -   10. Protection plug 1713 is replaced by the operator.    -   11. The normal flow rate is set by the operator as desired for        example via the interactive screen.

Reference is now made to FIG. 18A, FIG. 18B, FIG. 18C, 18D and FIG. 18E,which are schematic illustrations of an exemplary graphic user interface(GUI) used in operating the console, according to some embodiments ofthe present invention. The process of command screen and control consoleactivation of medication dispensing is shown.

Errors in medicine dispensing to patient as result of a variety ofreasons should be minimized due to their tragic results. Theproliferation of the internet of things (IOT) in today's designsprovides an opportunity for a closed cycle authentication system asdescribed here. By controlling the closed loop flow cycle from thephysician prescription to the medicine administration to patient allerrors may be minimized as desired.

Reference is now made to FIGS. 19A and 19B, which are block diagramsschematically representing a safety cycle of a medical pump use by amedical team, according to some embodiments of the present invention.

Since radio-frequency identification devices (RFIDs) are capable ofcontaining a large quantity of data (>8000 byte), the large capacity maybe taken advantage of to add a complete medication and treatment profileto the dispensed medication which is shown later to control andauthenticate the medication before administration to the patient and tocheck it's compliance with the physicians instructions as inserted tothe electronic health record (EHR).

As shown, the closed loop is beginning with the physician's directionand terminating with the medication administration to the patient, forexample by the care taking nurse.

The physician starts the cycle by punching into the EHR his recipe anddirection of use for specific patient under his care.

The data is then delivered to the server and the patient console (aterminal associated with the patient, optionally stored at a bedside ofthe patient) as well as to the pharmacy. The data may include, forexample, medication type, dose, administration and/or patientidentification (ID).

Pharmacy prepares the medication in a container such, as a syringe,equipped with an RFID containing patient ID data as well as medicationdata and dosage. The RFID may be attached to the container of themedication, for example.

Medication container is delivered to the point of care (POC).

Medication RFID is matched with the information in the patient console.

If matching, medication is administered to patient, if mismatched thewhole cycle is rechecked.

The descriptions of the various embodiments of the present inventionhave been presented for purposes of illustration, but are not intendedto be exhaustive or limited to the embodiments disclosed. Manymodifications and variations will be apparent to those of ordinary skillin the art without departing from the scope and spirit of the describedembodiments. The terminology used herein was chosen to best explain theprinciples of the embodiments, the practical application or technicalimprovement over technologies found in the marketplace, or to enableothers of ordinary skill in the art to understand the embodimentsdisclosed herein.

It is expected that during the life of a patent maturing from thisapplication many relevant medical pumps will be developed and the scopeof the term medical pump is intended to include all such newtechnologies a priori.

The terms “comprises”, “comprising”, “includes”, “including”, “having”and their conjugates mean “including but not limited to”. This termencompasses the terms “consisting of” and “consisting essentially of”.

The phrase “consisting essentially of” means that the composition ormethod may include additional ingredients and/or steps, but only if theadditional ingredients and/or steps do not materially alter the basicand novel characteristics of the claimed composition or method.

As used herein, the singular form “a”, “an” and “the” include pluralreferences unless the context clearly dictates otherwise. For example,the term “a compound” or “at least one compound” may include a pluralityof compounds, including mixtures thereof.

The word “exemplary” is used herein to mean “serving as an example,instance or illustration”. Any embodiment described as “exemplary” isnot necessarily to be construed as preferred or advantageous over otherembodiments and/or to exclude the incorporation of features from otherembodiments.

The word “optionally” is used herein to mean “is provided in someembodiments and not provided in other embodiments”. Any particularembodiment of the invention may include a plurality of “optional”features unless such features conflict.

Throughout this application, various embodiments of this invention maybe presented in a range format. It should be understood that thedescription in range format is merely for convenience and brevity andshould not be construed as an inflexible limitation on the scope of theinvention. Accordingly, the description of a range should be consideredto have specifically disclosed all the possible subranges as well asindividual numerical values within that range. For example, descriptionof a range such as from 1 to 6 should be considered to have specificallydisclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numberswithin that range, for example, 1, 2, 3, 4, 5, and 6. This appliesregardless of the breadth of the range.

Whenever a numerical range is indicated herein, it is meant to includeany cited numeral (fractional or integral) within the indicated range.The phrases “ranging/ranges between” a first indicate number and asecond indicate number and “ranging/ranges from” a first indicate number“to” a second indicate number are used herein interchangeably and aremeant to include the first and second indicated numbers and all thefractional and integral numerals therebetween.

It is appreciated that certain features of the invention, which are, forclarity, described in the context of separate embodiments, may also beprovided in combination in a single embodiment. Conversely, variousfeatures of the invention, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable subcombination or as suitable in any other describedembodiment of the invention. Certain features described in the contextof various embodiments are not to be considered essential features ofthose embodiments, unless the embodiment is inoperative without thoseelements.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims.

It is the intent of the Applicant(s) that all publications, patents andpatent applications referred to in this specification are to beincorporated in their entirety by reference into the specification, asif each individual publication, patent or patent application wasspecifically and individually noted when referenced that it is to beincorporated herein by reference. In addition, citation oridentification of any reference in this application shall not beconstrued as an admission that such reference is available as prior artto the present invention. To the extent that section headings are used,they should not be construed as necessarily limiting. In addition, anypriority document(s) of this application is/are hereby incorporatedherein by reference in its/their entirety.

What is claimed is:
 1. An enteral feeding system, comprising: (i) adisposable system portion, comprising: a plurality of disposable inlettubes connected to a plurality of fluid bags containing feed material; adisposable fluid chamber having at least two intake openings connectedto the inlet tubes, sealed by at least one intake valve, and an outletopening sealed by an outlet valve; the disposable fluid chamber includesa piston which is sealing said fluid chamber, wherein said piston isconnected to a non-disposable drive mechanism, said non-disposable drivemechanism pulls said piston to draw fluid from one of said at least twointake openings and pushes said piston to discharge said fluid into saidoutlet opening, wherein the disposable fluid chamber and said pluralityof disposable inlet tubes are detachable from a housing; and (ii) anon-disposable reusable portion, comprising: the non-disposable drivemechanism, the housing, and a selecting valve enclosing at least twotubes, each providing fluid to one of said at least two intake openings,wherein said selecting valve closes one of said at least two tubes whileopening another of said at least two tubes, wherein the selecting valveis not in contract with fluid in the at least two tubes.
 2. The enteralfeeding system of claim 1, wherein the housing includes an easy to mountmechanism for connecting and detaching therein at least part of thedisposable system portion, the easy to mount mechanism of the housingcomprising a first opening designed to connect to and release a plungerrod of the piston, a second opening designed to connect to and releasean outlet tube connected to the outlet opening, and at least two thirdopenings designed to connect to and release the plurality of disposableinlet tubes.
 3. The enteral feeding system of claim 1, wherein said atleast one intake valve and said outlet valve are incorporated in anumbrella type valve box.
 4. The enteral feeding system of claim 3,wherein when the piston moves up the umbrella valve flips up, aninternal port of the umbrella valve is closed, fluid flows beneath anumbrella valve and suction is performed from an active inlet opened bythe selecting valve.
 5. The enteral feeding system of claim 3, whereinwhen the piston moves down the umbrella valve flips down and theinternal port of the umbrella valve opens.
 6. The enteral feeding systemof claim 1, wherein said at least one intake valve and said outlet valveare incorporated in a valve box selected from a group consisting of:duckbill type, and poppet type.
 7. The enteral feeding system of claim1, wherein a first fluid bag of the plurality of fluid bags containsfeed material and is connected to a first second disposable tube of thedisposable manifold of inlet tubes, and a second fluid bag of theplurality of fluid bags contains water and is connected to a seconddisposable tube of the disposable manifold of inlet tubes.
 8. Theenteral feeding system of claim 7, wherein an amount of feeding fluidand amount of water that is pumped at a first stage is calculated sothat a total amount of feeding fluid during a feeding cycle is equal toa prescribed amount of feeding fluid for the feeding cycle.
 9. Theenteral feeding system of claim 1, further comprising a controllerconfigured to administer two or more fluids from different fluid bagscontinuously according to a programmed administration plan bycontrolling the selecting valve that selects flow from the tubesconnected to the different fluid sources.
 10. The enteral feeding systemof claim 1, wherein said piston is connected to said non-disposabledrive mechanism via a plunger rod having a slit which holds areciprocating drive bracket of said non-disposable drive mechanism andtransfers reciprocal motion of said non-disposable drive mechanism. 11.The enteral feeding system of claim 10, wherein said reciprocating drivebracket includes a fork type holder holding said slit.
 12. The enteralfeeding system of claim 11, wherein the slit of the plunger rod isdesigned to enable a quick mounting and removal of the disposable fluidchamber from the reciprocating drive bracket.
 13. The enteral feedingsystem of claim 10, wherein when the disposable fluid chamber is mountedin the housing of console, the reciprocating drive bracket is capable ofpulling and pushing the plunger thus performing a desired pumpingaction.
 14. The enteral feeding system of claim 1, at least one of: (i)wherein said non-disposable drive mechanism is controlled by anelectronic control unit, and (ii) wherein said selecting valve iscontrolled by an electronic control unit.
 15. The enteral feeding systemof claim 1, wherein at least one of said selecting valve, said at leastone intake valve and said outlet valve, is a one way valve.
 16. Theenteral feeding system of claim 1, wherein said selecting valve isinstructed by an electronic control unit to alternately open and closesaid at least two tubes.
 17. The enteral feeding system of claim 1,further comprising an electronic control unit which is at least one of:(i) connected to a display device, graphically displaying data relatedto operation of said enteral feeding system, (ii) connected to anelectronic health record (EHR), (iii) provides instructions whichcompensate for food losses due to gastric residual volume (GRV) andreflux feeding pause, (iv) wherein said non-disposable drive mechanismis adjusted by the electronic control unit to administer a medicationfrom a fluid dispenser connected to one of said at least two intakeopenings.
 18. The enteral feeding system of claim 1, at least one of:(i) wherein one of said at least two tubes includes a fluid dispenserhaving a detachable fluid container, (ii) wherein said at least twointake openings are connected into an intake channel, and (iii) whereinsaid selecting valve is a pinch valve.
 19. The enteral feeding system ofclaim 1, further comprising a controller configured to operate thenon-disposable drive mechanism and the selecting valve according to apreprogrammed schedule for achieving a feeding goal.
 20. The enteralfeeding system of claim 19, wherein said preprogrammed schedule isupdated during operation according to at least one of data obtained fromsensors and a user for tracking the feeding goal.